Severe structural and functional visual system damage leads to profound loss of vision-related quality of life in patients with neuromyelitis optica spectrum disorders

Schmidt, Felix; Zimmermann, Hanna; Mikolajczak, Janine; Oertel, Frederike Cosima; Pache, Florence; Weinhold, Maria; Schinzel, Johann; Bellmann‐Strobl, Judith; Ruprecht, Klemens; Paul, Friedemann; Brandt, Alexander U.

doi:10.1016/j.msard.2016.11.008

Cited by 93 publications

(79 citation statements)

References 23 publications

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“…Our current study showed significantly reduced gray matter volume in the left thalamus, left calcarine, and right lingual gyrus (which are constituents of the primary visual network). Visual impairment, a key clinical manifestation in NMOSD after ON, has been reported to affect the quality of life (Schmidt et al, 2017) since it may lead to blindness (Collongues et al, 2010;Kitley et al, 2012). Thinning of the visual cortex and impaired microstructural integrity restricted to the optic radiation are consistent neuroimaging reports shown in patients with NMOSD (Matthews et al, 2015;Pache et al, 2016).…”

Section: Discussionsupporting

confidence: 52%

“…Functional MRI is a neuroimaging modality that processes neural activity changes in deoxyhemoglobin levels (blood oxygen level-dependent [BOLD] signal). Thus far, two common methodologies have been suggested: (1) activation fMRI, which evaluates deoxyhemoglobin signal modification during specified tasks, and (2) resting-state fMRI, which associates the synchrony of low-frequency fluctuations of the BOLD signal in various regions while the brain is at rest; accordingly, this technique has been used to determine the FC of neural networks in the brain (Schmidt et al, 2017). Using fMRI, Rocca et al (2004) showed an irregular form of movement associated with cortical activation in patients with NMOSD that extended beyond the sensorimotor network and involved the visual network of the brain.…”

Section: Discussionmentioning

confidence: 99%

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Alterations in the Brain Structure and Functional Connectivity in Aquaporin-4 Antibody-Positive Neuromyelitis Optica Spectrum Disorder

et al. 2020

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Purpose: To investigate the mechanisms underlying the gray matter volume (GMV) and functional connectivity (FC) changes in aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (NMOSD) patients. Methods:This cross-sectional study consisted of 21 patients with aquaporin-4 antibody-positive NMOSD and 22 age-and sex-matched healthy controls. All participants underwent cerebral magnetic resonance imaging and testing each individual's visual acuity was done.Results: Neuromyelitis optica spectrum disorder patients showed significantly reduced GMV in the left calcarine, left thalamus and right lingual gyrus of the NMOSD patients when compared to HC (P < 0.05). NMOSD patients showed significantly decreased FC values (P < 0.05) in both the left and right calcarine, right lingual gyrus and left thalamus, respectively, when compared to HC. We also observed a positive correlation between the FC values of the left thalamus, bilateral calcarine gyrus and the visual acuity, respectively (P < 0.05). Furthermore, a negative association was seen between the duration of the disease, frequency of optic neuritis, and the FC values in the lingual gyrus, bilateral calcarine gyrus, and right lingual gyrus, respectively (P < 0.05). Conclusion:Reduced visual acuity and frequency of optic neuritis are associated with alterations in the GMV and FC in NMOSD. Our current study, which provides imaging evidence on the impairment involved in NMOSD, sheds light on pathophysiological responses of optic neuritis attack on the brain especially on the visual network.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Alterations in the Brain Structure and Functional Connectivity in Aquaporin-4 Antibody-Positive Neuromyelitis Optica Spectrum Disorder

et al. 2020

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“…One such study demonstrated that an immediate unilateral blindness occurred in a third of patients after the first optic neuritis (ON), and generally two attacks are sufficient to cause a definitive loss of vision. [3132] Bonnan et al gathered data from various studies which showed a clear effect of PLEX delay since success rate was 8/8 (100%) during the first 11 days, then 4/7 (57%) from days 12 to 22, and 7/13 (53%) from days 23 to 73. [12] Furthermore, even when patients recovered, the mean residual visual acuity tended to be lower in delayed PLEX patients.…”

Section: Future Of Plex In Management Of Nmosdmentioning

confidence: 99%

Plasma exchange as a first line therapy in acute attacks of neuromyelitis optica spectrum disorders

Kumawat

Choudhary

Sharma

et al. 2019

Ann Indian Acad Neurol

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“…Typically, MS-associated ON presents with subacute blurry vision with reduced contrast sensitivity or complete visual loss in one or-much less frequentlyboth eyes developing during hours or days associated with dyschromatopsia and pain during eye movement [16]. By contrast, NMOSD-associated ON, which is also one of the NMOSD core clinical characteristics, often presents with atypical symptoms, such as binocular affection and more pronounced visual loss with a worse recovery rate compared to MS [17][18][19][20][21]. Due to pathophysiological similarities between MS-associated ON and MS brain lesions with regard to inflammatory T-cell microglial activation and subsequent axonal degradation, optic neuritis serves as a concrete model of neuroinflammatory damage in the visual system [16].…”

Section: Visual Pathway In Neuroinflammatory Diseasesmentioning

confidence: 99%

“…While the entire visual pathway is profoundly susceptible to inflammatory damage [24], and although visual dysfunction has a major impact on patients' quality of life [19,60,61] …”

Section: Multimodal Objective Cns Visual Pathway Assessmentmentioning

confidence: 99%

Diffusion tensor imaging for multilevel assessment of the visual pathway: possibilities for personalized outcome prediction in autoimmune disorders of the central nervous system

et al. 2017

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The afferent visual pathway represents the most frequently affected white matter pathway in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). Diffusion tensor imaging (DTI) can reveal microstructural or non-overt brain tissue damage and quantify pathological processes. DTI facilitates the reconstruction of major white matter fiber tracts allowing for the assessment of structure-function and damage-dysfunction relationships. In this review, we outline DTI studies investigating the afferent visual pathway in idiopathic optic neuritis (ON), NMOSD, and MS. Since MS damage patterns are believed to depend on multiple factors, i.e., ON (anterior visual pathway damage), inflammatory lesions (posterior visual pathway damage), and global diffuse inflammatory and neurodegenerative processes, comprehensive knowledge on different contributing factors using DTI in vivo may advance our understanding of MS disease pathology. Combination of DTI measures and visual outcome parameters yields the potential to improve routine clinical diagnostic procedures and may further the accuracy of individual prognosis with regard to visual function and personalized disease outcome. However, due to the inherent limitations of DTI acquisition and post-processing techniques and the so far heterogeneous and equivocal data of previous studies, evaluation of the true potential of DTI as a possible biomarker for afferent visual pathway dysfunction is still substantially limited. Further research efforts with larger longitudinal studies and standardized DTI acquisition and post-processing validation criteria are needed to overcome current DTI limitations. DTI evaluation at different levels of the visual pathway has the potential to provide markers for individual damage evaluation in the future. As an imaging biomarker, DTI may support individual outcome prediction during personalized treatment algorithms in MS and other neuroinflammatory diseases, hereby leveraging the concept of predictive, preventive, and personalized medicine in the field of clinical neuroimmunology.

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Severe structural and functional visual system damage leads to profound loss of vision-related quality of life in patients with neuromyelitis optica spectrum disorders

Cited by 93 publications

References 23 publications

Alterations in the Brain Structure and Functional Connectivity in Aquaporin-4 Antibody-Positive Neuromyelitis Optica Spectrum Disorder

Alterations in the Brain Structure and Functional Connectivity in Aquaporin-4 Antibody-Positive Neuromyelitis Optica Spectrum Disorder

Plasma exchange as a first line therapy in acute attacks of neuromyelitis optica spectrum disorders

Diffusion tensor imaging for multilevel assessment of the visual pathway: possibilities for personalized outcome prediction in autoimmune disorders of the central nervous system

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